Biomechanical considerations of the diabetic foot

Abnormal functioning of the diabetic foot due to intrinsic complications of diabetes mellitus or secondary to idiopathic or iatrogenic deformity frequently predisposes the foot to ulceration, gangrene, and amputation. Biomechanical abberations in the feet of patients with diabetes are therefore significant risk factors for lower extremity complications. The author briefly reviews normal biomechanical principles and discusses four major contributing factors to the abnormal mechanics of the diabetic foot: neuropathy, structural deformity, gait abnormalities, and limited joint mobility. Through an appreciation of these complications of diabetes mellitus and attendant treatment focused on mitigating their influence in the causation of abnormal foot pressures and mechanics, preventive strategies can effectively be employed to reduce the incidence of foot ulceration and their tragic sequelae. Strategies that also include early intervention, patient education, and a multidisciplinary team approach play critical roles in the optimal management of patients with diabetes mellitus. Only through cohesive efforts based on a thorough understanding of the pathogenesis of diabetic foot lesions and primary or secondary prevention of such lesions can we hope to attain the goal of a fifty percent reduction in lower extremity amputation by the year 2000.